Table 1 contains the per claimant expenditure (Cost) of each mental health condition in the 12-month period 3/2020-2/2021 together with its contributing factors: price per episode (Price), episode intensity (EPR), and patient proportion (PCR). These quantities are obtained for patients in five age groups as well as for patients in all age groups combined. In this period, the per claimant expenditure on all conditions was $460.18 per month, of which $8.12 was spent on depression, $3.63 on anxiety, $0.46 on anorexia, $0.19 on bulimia, $3.11 on treating patients for alcohol use, and $0.96 on treating patients for opioid use.
Table 2 shows the rates of change (with 95% confidence intervals) and the financial impacts of change in the contributing factors together with the overall financial impact (Overall) from the yearly analysis. Table 3 summarizes the types of detected changes shown in Table 2 (with moderate or strong statistical significance) and over financial impacts for patients in all age groups combined. Table 4 contains the results of the quarterly analysis, also for patients in all age groups combined.
3.1. Depression and Generalized Anxiety Disorder
In the yearly analysis (Tables 2 & 3), increases in patient proportion of depression and anxiety for all age groups combined are detected in both pandemic and pre-pandemic periods. The patient proportion of anxiety grew at a higher rate in the pandemic period (13.7% versus 10.0%), which, along with a higher rate of increase in price per episode (5.5% versus 4.3%), resulted in a greater increase in per claimant expenditure ($0.61 versus $0.41 per month). The patient proportion of depression grew at a lower rate in the pandemic period (3.7% versus 6.9%), but per claimant expenditure grew by the same amount due to an increase in price per episode (4.8%). As a result of these changes in patient proportion, the excess rate and financial impact (Figures 1a and 1b) are negative for depression but positive for anxiety.
When broken down into age groups (Table 2), depression for all age groups had a lower rate of increase in patient proportion in the pandemic period; anxiety had a higher rate of increase in patient proportion for all age groups except age group 0-17 where the rate was lower. For depression, the price per episode increased mainly in age group 35-44, but for anxiety, it increased mainly in age group 18-34.
In the quarterly analysis of patients in all age groups combined (Table 4), all six pandemic periods saw an increase in patient proportion of anxiety; a decrease in patient proportion of depression was detected only in the summer of 2020 (period 2), and the remaining periods had either an increase (periods 1 and 4-6) or no change (period 3). For anxiety, the observed excess rate and financial impact of change in patient proportion (Figures 2a and 2b) were positive in all periods except the summer and fall of 2020 (periods 2 and 3); the nearly 15% excess rate in the spring of 2020 (period 1) was a main contributor to the overall positive excess rate for the following 12-month pandemic period (Figure 1a). In contrast, the observed excess rate and financial impact of change in patient proportion of depression (Figures 2a and 2b) were negative in the summer and fall of 2020 (periods 2 and 3) and in the summer of 2021 (period 6); the nearly -15% excess rate in the summer of 2020 (period 2) was the main contributor to the overall negative excess rate for the 12-month pandemic period (Figure 1a).
The price per episode of depression and anxiety increased in all quarterly pandemic periods except the spring of 2020 (period 1). The increased price per episode of depression in the summer of 2020 (period 2) drove the overall expenditure up despite a decrease in patient proportion. The price per episode of anxiety played a lesser role in the overall financial impact.
3.2. Eating Disorders
In the yearly analysis for anorexia (Table 2), a 20.3% increase in patient proportion was detected in the pandemic period for patients in all age groups combined, but it jumped to 40.2% for patients under age 18; the observed excess rate of change also increased from about 10% to 30% when comparing the same groups (Figure 1c), whereas the observed excess financial impacts were comparable (Figure 1d). Unexpectedly, considering all patients treated for bulimia, another eating disorder, an increased patient proportion detected in the pre-pandemic period was not present in the pandemic period.
The quarterly analysis (Table 4) shows that an increase in patient proportion of anorexia was detected not in the earlier periods of the pandemic but in the fall of 2020 and thereafter (periods 3-6), and the observed excess rate and financial impact (Figures 2c and 2d) became much higher in the winter of 2020 and thereafter (period 4-6). An increase in patient proportion of bulimia was detected early in the spring of 2020 (period 1) associated with the lockdowns, and later in the winter of 2020 and thereafter (periods 4-6); the over -20% excess rate in the summer of 2020 (period 2) determined the overall negative excess rate for the 12-month pandemic period (Figure 1c).
3.3 Alcohol and Opioid Use
For the yearly analysis (Tables 2 & 3), a 4.8% decrease in the patient proportion for treating alcohol use was detected in the pandemic period when all age groups were combined; this decrease was accompanied by a 19.2% increase in price per episode, resulting in a greater increase in the overall expenditure compared to the pre-pandemic period ($0.36 versus $0.01). For patients in age group 18-34 (Table 2), there was a more pronounced 17.9% decrease in patient proportion, together with a 26.3% increase in price per episode; the observed excess rate for patient proportion was over -15% (Figure 1e). For the same age group, a decrease in patient proportion for treating opioid use was also detected in the pandemic period, but the observed excess rate and financial impact were positive (Figures 1e and 1f).
For the quarterly analysis (Table 4), a decrease in patient proportion for treating alcohol use was detected in the summer and fall of 2020 (periods 2 and 3) which largely determined the overall negative excess rate of patient proportion in the 12-month pandemic period (Figure 1e). In the summer of 2020 (period 2), a 20.7% increase in price per episode dominated a 9.9% decrease in patient proportion and drove up the per claimant expenditure in this period by $0.44. For treating opioid use, an increase in patient proportion was detected earlier in the spring of 2020 (period 1); the observed excess rate in this period was over 15% (Figure 2e), but it was offset by a decrease in the summer of 2020 (period 2), resulting in a small positive excess rate in the yearly assessment in the pandemic period (Figure 1e). In the remaining quarterly periods, the observed excess rate and financial impact of change in patient proportion (Figures 2e and 2f) were all negative for treating opioid use.